Diagnostic utility of electrocardiogram for screening of cardiac injury on cardiac magnetic resonance in post-hospitalised COVID-19 patients: a prospective multicenter study
The role of ECG in ruling out myocardial complications on cardiac magnetic resonance (CMR) is unclear. We examined the clinical utility of ECG in screening for cardiac abnormalities on CMR among post-hospitalised COVID-19 patients. Post-hospitalised patients (n = 212) and age, sex and comorbidity-ma...
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| Veröffentlicht in: | International journal of cardiology 2024-11, Vol.415, p.132415, Article 132415 |
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| creator | Samat, Azlan Helmy Abd Cassar, Mark P. Akhtar, Abid M. McCracken, Celeste Ashkir, Zakariye M. Mills, Rebecca Moss, Alastair J. Finnigan, Lucy E.M. Lewandowski, Adam J. Mahmod, Masliza Ogbole, Godwin I. Tunnicliffe, Elizabeth M. Lukaschuk, Elena Piechnik, Stefan K. Ferreira, Vanessa M. Nikolaidou, Chrysovalantou Rahman, Najib M. Ho, Ling-Pei Harris, Victoria C. Singapuri, Amisha Manisty, Charlotte O'Regan, Declan P. Weir-McCall, Jonathan R. Steeds, Richard P. LLM, Krisnah Poinasamy Cuthbertson, Dan J. Kemp, Graham J. Horsley, Alexander Miller, Christopher A. O'Brien, Caitlin Chiribiri, Amedeo Francis, Susan T. Chalmers, James D. Plein, Sven Poener, Ana-Maria Wild, James M. Treibel, Thomas A. Marks, Michael Toshner, Mark Wain, Louise V. Evans, Rachael A. Brightling, Christopher E. Neubauer, Stefan McCann, Gerry P. Raman, Betty |
| description | The role of ECG in ruling out myocardial complications on cardiac magnetic resonance (CMR) is unclear. We examined the clinical utility of ECG in screening for cardiac abnormalities on CMR among post-hospitalised COVID-19 patients.
Post-hospitalised patients (n = 212) and age, sex and comorbidity-matched controls (n = 38) underwent CMR and 12‑lead ECG in a prospective multicenter follow-up study. Participants were screened for routinely reported ECG abnormalities, including arrhythmia, conduction and R wave abnormalities and ST-T changes (excluding repolarisation intervals). Quantitative repolarisation analyses included corrected QT (QTc), corrected QT dispersion (QTc disp), corrected JT (JTc) and corrected T peak-end (cTPe) intervals.
At a median of 5.6 months, patients had a higher burden of ECG abnormalities (72.2% vs controls 42.1%, p = 0.001) and lower LVEF but a comparable cumulative burden of CMR abnormalities than controls. Patients with CMR abnormalities had more ECG abnormalities and longer repolarisation intervals than those with normal CMR and controls (82% vs 69% vs 42%, p |
| doi_str_mv | 10.1016/j.ijcard.2024.132415 |
| format | Article |
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Post-hospitalised patients (n = 212) and age, sex and comorbidity-matched controls (n = 38) underwent CMR and 12‑lead ECG in a prospective multicenter follow-up study. Participants were screened for routinely reported ECG abnormalities, including arrhythmia, conduction and R wave abnormalities and ST-T changes (excluding repolarisation intervals). Quantitative repolarisation analyses included corrected QT (QTc), corrected QT dispersion (QTc disp), corrected JT (JTc) and corrected T peak-end (cTPe) intervals.
At a median of 5.6 months, patients had a higher burden of ECG abnormalities (72.2% vs controls 42.1%, p = 0.001) and lower LVEF but a comparable cumulative burden of CMR abnormalities than controls. Patients with CMR abnormalities had more ECG abnormalities and longer repolarisation intervals than those with normal CMR and controls (82% vs 69% vs 42%, p < 0.001). Routinely reported ECG abnormalities had poor discriminative ability (area-under-the-receiver-operating curve: AUROC) for abnormal CMR, AUROC 0.56 (95% CI 0.47–0.65), p = 0.185; worse among female than male patients. Adding JTc and QTc disp improved the AUROC to 0.64 (95% CI 0.55–0.74), p = 0.002, the sensitivity of the ECG increased from 81.6% to 98.0%, negative predictive value from 84.7% to 96.3%, negative likelihood ratio from 0.60 to 0.13, and reduced sex-dependence variabilities of ECG diagnostic parameters.
Post-hospitalised COVID-19 patients have more ECG abnormalities than controls. Normal ECGs, including normal repolarisation intervals, reliably exclude CMR abnormalities in male and female patients.
•What is new?•Electrocardiography (ECG) is a pragmatic and reliable first-line method for screening post-hospitalised COVID-19 patients for myocardial abnormalities based on cardiac magnetic resonance (CMR).•We demonstrate an optimised sex-independent approach for using the ECG in screening patients for post-COVID CMR abnormalities.•What are the clinical implications?•Post-hospitalised COVID-19 patients with normal ECG (and normal repolarisation parameters) can be reassured their risk of myocardial injury is low and may not need further investigation with CMR.•A 12-lead ECG with normal repolarisation intervals can reliably be used for screening to exclude cardiac abnormalities on CMR in both sexes with high diagnostic confidence. It may minimise unnecessary CMR referrals to improve the global financial burden on healthcare systems.</description><identifier>ISSN: 0167-5273</identifier><identifier>ISSN: 1874-1754</identifier><identifier>EISSN: 1874-1754</identifier><identifier>DOI: 10.1016/j.ijcard.2024.132415</identifier><identifier>PMID: 39127146</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>CMR ; ECG ; Electrocardiogram ; Repolarisation ; SARS-CoV-2</subject><ispartof>International journal of cardiology, 2024-11, Vol.415, p.132415, Article 132415</ispartof><rights>2024 The Authors</rights><rights>Copyright © 2024. Published by Elsevier B.V.</rights><rights>Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c241t-ef1d60433450abd0769bb69e83c2650e64803de17a6beeb25b0e540a8eea72773</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.ijcard.2024.132415$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,777,781,3537,27905,27906,45976</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39127146$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Samat, Azlan Helmy Abd</creatorcontrib><creatorcontrib>Cassar, Mark P.</creatorcontrib><creatorcontrib>Akhtar, Abid M.</creatorcontrib><creatorcontrib>McCracken, Celeste</creatorcontrib><creatorcontrib>Ashkir, Zakariye M.</creatorcontrib><creatorcontrib>Mills, Rebecca</creatorcontrib><creatorcontrib>Moss, Alastair J.</creatorcontrib><creatorcontrib>Finnigan, Lucy E.M.</creatorcontrib><creatorcontrib>Lewandowski, Adam J.</creatorcontrib><creatorcontrib>Mahmod, Masliza</creatorcontrib><creatorcontrib>Ogbole, Godwin I.</creatorcontrib><creatorcontrib>Tunnicliffe, Elizabeth M.</creatorcontrib><creatorcontrib>Lukaschuk, Elena</creatorcontrib><creatorcontrib>Piechnik, Stefan K.</creatorcontrib><creatorcontrib>Ferreira, Vanessa M.</creatorcontrib><creatorcontrib>Nikolaidou, Chrysovalantou</creatorcontrib><creatorcontrib>Rahman, Najib M.</creatorcontrib><creatorcontrib>Ho, Ling-Pei</creatorcontrib><creatorcontrib>Harris, Victoria C.</creatorcontrib><creatorcontrib>Singapuri, Amisha</creatorcontrib><creatorcontrib>Manisty, Charlotte</creatorcontrib><creatorcontrib>O'Regan, Declan P.</creatorcontrib><creatorcontrib>Weir-McCall, Jonathan R.</creatorcontrib><creatorcontrib>Steeds, Richard P.</creatorcontrib><creatorcontrib>LLM, Krisnah Poinasamy</creatorcontrib><creatorcontrib>Cuthbertson, Dan J.</creatorcontrib><creatorcontrib>Kemp, Graham J.</creatorcontrib><creatorcontrib>Horsley, Alexander</creatorcontrib><creatorcontrib>Miller, Christopher A.</creatorcontrib><creatorcontrib>O'Brien, Caitlin</creatorcontrib><creatorcontrib>Chiribiri, Amedeo</creatorcontrib><creatorcontrib>Francis, Susan T.</creatorcontrib><creatorcontrib>Chalmers, James D.</creatorcontrib><creatorcontrib>Plein, Sven</creatorcontrib><creatorcontrib>Poener, Ana-Maria</creatorcontrib><creatorcontrib>Wild, James M.</creatorcontrib><creatorcontrib>Treibel, Thomas A.</creatorcontrib><creatorcontrib>Marks, Michael</creatorcontrib><creatorcontrib>Toshner, Mark</creatorcontrib><creatorcontrib>Wain, Louise V.</creatorcontrib><creatorcontrib>Evans, Rachael A.</creatorcontrib><creatorcontrib>Brightling, Christopher E.</creatorcontrib><creatorcontrib>Neubauer, Stefan</creatorcontrib><creatorcontrib>McCann, Gerry P.</creatorcontrib><creatorcontrib>Raman, Betty</creatorcontrib><creatorcontrib>on behalf of PHOSP-COVID Collaborative group</creatorcontrib><creatorcontrib>PHOSP-COVID Collaborative group</creatorcontrib><title>Diagnostic utility of electrocardiogram for screening of cardiac injury on cardiac magnetic resonance in post-hospitalised COVID-19 patients: a prospective multicenter study</title><title>International journal of cardiology</title><addtitle>Int J Cardiol</addtitle><description>The role of ECG in ruling out myocardial complications on cardiac magnetic resonance (CMR) is unclear. We examined the clinical utility of ECG in screening for cardiac abnormalities on CMR among post-hospitalised COVID-19 patients.
Post-hospitalised patients (n = 212) and age, sex and comorbidity-matched controls (n = 38) underwent CMR and 12‑lead ECG in a prospective multicenter follow-up study. Participants were screened for routinely reported ECG abnormalities, including arrhythmia, conduction and R wave abnormalities and ST-T changes (excluding repolarisation intervals). Quantitative repolarisation analyses included corrected QT (QTc), corrected QT dispersion (QTc disp), corrected JT (JTc) and corrected T peak-end (cTPe) intervals.
At a median of 5.6 months, patients had a higher burden of ECG abnormalities (72.2% vs controls 42.1%, p = 0.001) and lower LVEF but a comparable cumulative burden of CMR abnormalities than controls. Patients with CMR abnormalities had more ECG abnormalities and longer repolarisation intervals than those with normal CMR and controls (82% vs 69% vs 42%, p < 0.001). Routinely reported ECG abnormalities had poor discriminative ability (area-under-the-receiver-operating curve: AUROC) for abnormal CMR, AUROC 0.56 (95% CI 0.47–0.65), p = 0.185; worse among female than male patients. Adding JTc and QTc disp improved the AUROC to 0.64 (95% CI 0.55–0.74), p = 0.002, the sensitivity of the ECG increased from 81.6% to 98.0%, negative predictive value from 84.7% to 96.3%, negative likelihood ratio from 0.60 to 0.13, and reduced sex-dependence variabilities of ECG diagnostic parameters.
Post-hospitalised COVID-19 patients have more ECG abnormalities than controls. Normal ECGs, including normal repolarisation intervals, reliably exclude CMR abnormalities in male and female patients.
•What is new?•Electrocardiography (ECG) is a pragmatic and reliable first-line method for screening post-hospitalised COVID-19 patients for myocardial abnormalities based on cardiac magnetic resonance (CMR).•We demonstrate an optimised sex-independent approach for using the ECG in screening patients for post-COVID CMR abnormalities.•What are the clinical implications?•Post-hospitalised COVID-19 patients with normal ECG (and normal repolarisation parameters) can be reassured their risk of myocardial injury is low and may not need further investigation with CMR.•A 12-lead ECG with normal repolarisation intervals can reliably be used for screening to exclude cardiac abnormalities on CMR in both sexes with high diagnostic confidence. It may minimise unnecessary CMR referrals to improve the global financial burden on healthcare systems.</description><subject>CMR</subject><subject>ECG</subject><subject>Electrocardiogram</subject><subject>Repolarisation</subject><subject>SARS-CoV-2</subject><issn>0167-5273</issn><issn>1874-1754</issn><issn>1874-1754</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNp9kc1u1DAUhS0EotPCGyDkJZsMduzECQskNKWlUqVuaLeWY98MjvKH7VSah-IduWlKl6ws2d895_ocQj5wtueMl5-7ve-sCW6fs1zuucglL16RHa-UzLgq5GuyQ0xlRa7EGTmPsWOMybqu3pIzUfNccVnuyJ9Lb47jFJO3dEm-9-lEp5ZCDzaFadX30zGYgbZToNEGgNGPxxV5ejOW-rFbAg6NLzcDKsIqGCBOoxktIERnNMl-TXH2yfQ-gqOHu4eby4zXdDbJw5jiF2roHBBBc_8IdFh6lMEXQO-0uNM78qY1fYT3z-cFub_6_vPwI7u9u745fLvNLKaQMmi5K5kUQhbMNI6psm6asoZK2LwsGJSyYsIBV6ZsAJq8aBgUkpkKwKhcKXFBPm26uM3vBWLSg48W-t6MMC1RC4YBVpWqBKJyQy0uHgO0eg5-MOGkOdNrUbrTW1F6LUpvReHYx2eHpRnAvQz9awaBrxsA-M9HD0FHiyFZcD5gPNpN_v8OfwGtm6nz</recordid><startdate>20241115</startdate><enddate>20241115</enddate><creator>Samat, Azlan Helmy 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P.</au><au>LLM, Krisnah Poinasamy</au><au>Cuthbertson, Dan J.</au><au>Kemp, Graham J.</au><au>Horsley, Alexander</au><au>Miller, Christopher A.</au><au>O'Brien, Caitlin</au><au>Chiribiri, Amedeo</au><au>Francis, Susan T.</au><au>Chalmers, James D.</au><au>Plein, Sven</au><au>Poener, Ana-Maria</au><au>Wild, James M.</au><au>Treibel, Thomas A.</au><au>Marks, Michael</au><au>Toshner, Mark</au><au>Wain, Louise V.</au><au>Evans, Rachael A.</au><au>Brightling, Christopher E.</au><au>Neubauer, Stefan</au><au>McCann, Gerry P.</au><au>Raman, Betty</au><aucorp>on behalf of PHOSP-COVID Collaborative group</aucorp><aucorp>PHOSP-COVID Collaborative group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Diagnostic utility of electrocardiogram for screening of cardiac injury on cardiac magnetic resonance in post-hospitalised COVID-19 patients: a prospective multicenter study</atitle><jtitle>International journal of cardiology</jtitle><addtitle>Int J Cardiol</addtitle><date>2024-11-15</date><risdate>2024</risdate><volume>415</volume><spage>132415</spage><pages>132415-</pages><artnum>132415</artnum><issn>0167-5273</issn><issn>1874-1754</issn><eissn>1874-1754</eissn><abstract>The role of ECG in ruling out myocardial complications on cardiac magnetic resonance (CMR) is unclear. We examined the clinical utility of ECG in screening for cardiac abnormalities on CMR among post-hospitalised COVID-19 patients.
Post-hospitalised patients (n = 212) and age, sex and comorbidity-matched controls (n = 38) underwent CMR and 12‑lead ECG in a prospective multicenter follow-up study. Participants were screened for routinely reported ECG abnormalities, including arrhythmia, conduction and R wave abnormalities and ST-T changes (excluding repolarisation intervals). Quantitative repolarisation analyses included corrected QT (QTc), corrected QT dispersion (QTc disp), corrected JT (JTc) and corrected T peak-end (cTPe) intervals.
At a median of 5.6 months, patients had a higher burden of ECG abnormalities (72.2% vs controls 42.1%, p = 0.001) and lower LVEF but a comparable cumulative burden of CMR abnormalities than controls. Patients with CMR abnormalities had more ECG abnormalities and longer repolarisation intervals than those with normal CMR and controls (82% vs 69% vs 42%, p < 0.001). Routinely reported ECG abnormalities had poor discriminative ability (area-under-the-receiver-operating curve: AUROC) for abnormal CMR, AUROC 0.56 (95% CI 0.47–0.65), p = 0.185; worse among female than male patients. Adding JTc and QTc disp improved the AUROC to 0.64 (95% CI 0.55–0.74), p = 0.002, the sensitivity of the ECG increased from 81.6% to 98.0%, negative predictive value from 84.7% to 96.3%, negative likelihood ratio from 0.60 to 0.13, and reduced sex-dependence variabilities of ECG diagnostic parameters.
Post-hospitalised COVID-19 patients have more ECG abnormalities than controls. Normal ECGs, including normal repolarisation intervals, reliably exclude CMR abnormalities in male and female patients.
•What is new?•Electrocardiography (ECG) is a pragmatic and reliable first-line method for screening post-hospitalised COVID-19 patients for myocardial abnormalities based on cardiac magnetic resonance (CMR).•We demonstrate an optimised sex-independent approach for using the ECG in screening patients for post-COVID CMR abnormalities.•What are the clinical implications?•Post-hospitalised COVID-19 patients with normal ECG (and normal repolarisation parameters) can be reassured their risk of myocardial injury is low and may not need further investigation with CMR.•A 12-lead ECG with normal repolarisation intervals can reliably be used for screening to exclude cardiac abnormalities on CMR in both sexes with high diagnostic confidence. It may minimise unnecessary CMR referrals to improve the global financial burden on healthcare systems.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>39127146</pmid><doi>10.1016/j.ijcard.2024.132415</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0167-5273 |
| ispartof | International journal of cardiology, 2024-11, Vol.415, p.132415, Article 132415 |
| issn | 0167-5273 1874-1754 1874-1754 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_3091288783 |
| source | Elsevier ScienceDirect Journals |
| subjects | CMR ECG Electrocardiogram Repolarisation SARS-CoV-2 |
| title | Diagnostic utility of electrocardiogram for screening of cardiac injury on cardiac magnetic resonance in post-hospitalised COVID-19 patients: a prospective multicenter study |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-19T13%3A15%3A52IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Diagnostic%20utility%20of%20electrocardiogram%20for%20screening%20of%20cardiac%20injury%20on%20cardiac%20magnetic%20resonance%20in%20post-hospitalised%20COVID-19%20patients:%20a%20prospective%20multicenter%20study&rft.jtitle=International%20journal%20of%20cardiology&rft.au=Samat,%20Azlan%20Helmy%20Abd&rft.aucorp=on%20behalf%20of%20PHOSP-COVID%20Collaborative%20group&rft.date=2024-11-15&rft.volume=415&rft.spage=132415&rft.pages=132415-&rft.artnum=132415&rft.issn=0167-5273&rft.eissn=1874-1754&rft_id=info:doi/10.1016/j.ijcard.2024.132415&rft_dat=%3Cproquest_cross%3E3091288783%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=3091288783&rft_id=info:pmid/39127146&rft_els_id=S0167527324010374&rfr_iscdi=true |